I am a plastic surgeon in Little Rock, AR. I used to "suture for a living", I continue "to live to sew". These days most of my sewing is piecing quilts. I love the patterns and interplay of the fabric color. I would like to explore writing about medical/surgical topics as well as sewing/quilting topics. I will do my best to make sure both are represented accurately as I share with both colleagues and the general public.

Quilts of Valor

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Tuesday, July 10, 2007

Stenosing tenosynovitis is more commonly known as trigger finger or trigger thumb. It involves the pulleys and tendons in the hand. These tendons and pulley work together to bend the fingers. The tendons work like long ropes going from the muscles in the forearm to connect to the bones of the fingers and thumb. In the finger, the pulleys are a series of rings (made of connective tissue) that form a tunnel that the tendons must pass through. This is very much like the guides on a fishing rod through which the line (or tendon) passes. These pulleys hold the tendons close against the bone. The tendons and the pulley (tunnel) have a slick lining that allows easy gliding. Photo credit--ASSH.

When the tendon develops a nodule or swelling of its lining, it has difficulty passing through the pulley (which is not elastic, but fixed in diameter). The "popping" or "catching" feeling in the finger or thumb comes from the tendon "squeezing" through and giving as it makes it past the pulley. The swollen tendon is irritated more as it has to be squeezed through the pulley, producing more swelling. A vicious cycle of triggering, inflammation, and swelling. Sometimes the finger will become stuck (locked) and it may be hard to straighten or bend the finger. This is like having a finger swell and not being able to get your ring off.

So what causes this condition. Repetitive grasping of objects or an injury to the palm may irritate the flexor tendons. Medical conditions such as rheumatoid arthritis, gout, and diabetes may create swelling around the tendons which then lead to the "vicious" cycle of irritation/inflammation/swelling. Sometimes the cause is not clear.

So the goal of treatment is to eliminate the catching or locking and allow movement without discomfort. To do this the swelling around the tendon must be reduced to allow smooth gliding of the tendon. Wearing a splint or taking anti-inflammatory medication by mouth or injection into the area around the tendon (a corticosteroid shot) are ways to reduce the swelling. Changing how the hand is used, better body mechanics to reduce the impact or repetitive motions helps. If nonsurgical forms of treatment do not improve symptoms, then surgery may be recommended. This surgery is usually performed on an outpatient basis. Most often it is done using local anesthesia, but a regional (where only the arm is numbed) or a general may be used. The surgery cuts the pulley (only one and the finger still has other pulleys to keep it near the bone) which gives the tendon more room to glide, removing the restriction (cutting the ring off the swollen finger). Active motion of the finger is generally begun immediately after surgery. Normal use of the hand can be resumed once comfort permits.

Hello, I am a three time recipient of the trigger finger operation, my last release was last tuesday, When my doctor got in there though he found a exostosis,which he had to remove and I was wondering what makes these things grow and what can I do (or not do) to make these annoying things come back. I am a hairdresser and play the piano, guitar and flute. Thank you for your timekarela

Karela, as I mentioned above the usual causes of "trigger finger" is repetitive grasping of objects or an injury to the palm. So watch the posture of your hand when doing the activities you mentioned. Don't use your palm as a "hammer" as this can cause injury and swelling around the tendons.

If you have any of the medical conditions mentioned (such as rheumatoid arthritis, gout, and diabetes), do your best to keep them in check.

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